Abstract

Childhood cancer is curable. Malnutrition poses a major problem amongst Indian children with around 40% of them suffering from undernourishment and starvation. It is one of the causes of poor outcome and toxicity of cancer patients. This study will help to highlight the close knitted relationship between the nutritional status and its influence on complete remission, disease free survival (DFS) and chemotherapeutic toxicity. In the present study, 500 cancer affected children were analyzed, who were being treated during a period from Jan, 2007 to Dec, 2011. The age range was 1-18 years (mean 12.5 years). There was male preponderance. Distribution of cases: Acute lymphoblastic leukemia 42%, Acute myeloid leukemia 8%, Non Hodgkin's and Hodgkin's leukemia 14%, Rhabdomyosarcoma and other cancer tumors 12%, Germ cell tumor 8%, Brain tumor 4% and other 12%. During preliminary diagnosis of these patients prior to beginning of therapy, an initial anthropometry was done in all the cases that included measurements of Weight for age (WFA), Height for age (HFA), Mid arm circumference (MAC) and Biceps Skin Fold Thickness (BSFT). The values of these variables were compared with the ICMR recommended standards provided by percentile curve of the growth chart for that age and sex. BSFT lies between 3.8cm and 6.5cm but during malnutrition it falls below 3.8cm. We pursued initial diagnosis based on biochemical parameters, chiefly, serum total protein and serum albumin levels. The albumin level was considered normal if the value was equal to or more than 3g%. It was seen that 190 (38%) children were malnourished on diagnosis. The patients with malnutrition had poor outcome (45%) as compared to well-nourished children (80%). Malnourished children also showed significantly higher toxicity level (p < .0001). Hence we concluded that malnutrition was an important determinant factor for outcome of pediatric cancer patients. Next we would like to focus on assessment of nutritional status in children starting cancer chemotherapy, radiology and surgery.